I will begin by trying to give Senators some idea of the necessity for this Bill. There are a number of factors in the nursing problem with which we must now grapple. On the one hand, we have the increase which will be necessary in the number of nurses employed in the various expanding public health services according as they improve in the years immediately ahead, and on the other hand there is the fact that girls to-day do not seem to find the same attraction in the nursing profession as was once traditional.
To a certain extent the emigration of nurses is also an important factor. This may occur for a variety of reasons among which the financial one is not necessarily dominant. Conditions attaching to training elsewhere may appear to be more attractive and better prospects may seem to exist for trained nurses. A considerable amount has been done by administrative action in my Department to improve the lot of nurses who primarily are the responsibility of the Department of Health, those working in the local authority services, and the matter of remuneration for both hospital nurses and outdoor nurses in the public health services has been the subject of more than one review in recent years. In the case of many of our girls who have gone abroad to take up nursing, conditions which from a distance appeared to be particularly attractive have not in effect been sufficiently good to keep many of them there. Consequently a number are now returning to this country to take up nursing posts here. The return, however, of these exiles is not of such proportion as to render less necessary the taking of far reaching action to ensure an adequate number of nurses for our expanding services.
The problem of ensuring an adequate supply of nurses must, in the main, be attacked by the body or bodies responsible for the control of professional nurses. These two bodies at the present moment are the General Nursing Council and the Central Midwives Board. The powers which these two bodies have at the moment have been reviewed in consultation with the two bodies and my Department and they are quite obviously inadequate. If we are to try to avoid the very serious crisis which may arise from a shortage of nursing personnel to meet our growing needs it would be necessary to stimulate, by special measures, the recruitment of certain categories of nurses and this cannot be done by the existing bodies. We have, therefore, to approach the matter from the most effective manner in which the profession of nurses should be organised in the future. The establishment of a unified body representative of all the interests concerned, which would have adequate powers to deal with the many problems likely to arise is regarded as the best solution, and the present Bill has been prepared for that purpose. The explanatory memorandum circulated with it indicates its main purposes and makes it unnecessary for me to repeat them in detail.
The principal provisions in the Bill are that the Central Midwives Board and the General Nursing Council should be replaced by a single body which should control both nursing and midwifery, which will in future be treated as a branch of nursing. The necessity for termination of the legal segregation of maternity nursing from other branches will be apparent when it is realised that the job of the maternity nurse is no longer so clearly defined from the general practice of nursing as it used to be. Special training in the nursing of infants is coming to be looked upon as an essential part of the equipment of a maternity nurse. I may also say, while I have the highest appreciation of the midwifery profession as it exists and the stringent but necessary discipline under which they carry on, I am also satisfied that the determination of the legal distinction will tend, if anything, to improve the status and prestige of the maternity nurse. Personnel difficulties have not so far emerged with regard to midwives but it will be realised that the need for special measures for training are needed and the board will have power to deal with the problem by contrast with the limited powers of the present governing body.
The constitution of the board will be found in the main in clauses 12 and 13 of the Bill where it is proposed that 13 members should be appointed by the Minister following consultation, in the case of nine of these 13 appointments, with the appropriate bodies, where such exist, and that ten members should be elected. With a view to implementing the proposals of the Bill as quickly as possible—and I might add on the suggestion of one of the nursing bodies—it is considered desirable to make provision for the appointment of the entire first board by the Minister. This is a proposal which for obvious reasons did not readily commend itself to me. The proposal is put forward purely for the reasons that in using it it might possibly save time.
It is considered that the regulations governing the details of the election of members of the board will need to be detailed and extensive and would, if we had to wait for them, delay the bringing into operation of the Bill if and when it is enacted. Provision is made, however, under which the first board will hold office for approximately three years only in order that the various interested bodies may have at as early a date as possible an opportunity of electing representatives to the board. Even in the case of the first board the Minister is required to consult, where feasible, representative bodies regarding nine of the 13 nominated bodies. I hope that the proposed constitution of the board will be regarded as satisfactory as it has been the intention to set up a body representative of nursing interests which would have wide powers in connection with the future control and development of the nursing profession.
The integration of the professions of nurse and maternity nurse have not been plain sailing. In this I have been aided by advice from the existing controlling bodies. I have been impressed by the case put forward for a high degree of specialised knowledge in relation to certain problems of control of maternity nursing. The existing law recognises a difference in problems of control as between midwives and State-registered nurses and the law governing midwives lays down more detailed provision for discipline than in the case of the State-registered nurse. On the one hand, because of the nature of the maternity nurse's work, and on the other by reason of the fact that her work is often of necessity less closely supervised than that of the great bulk of State-registered nurses, it is apparent that the maintenance of a distinction in the disciplinary codes and the continual utilisation of specialised knowledge in relation to problems of discipline in the field of maternity nursing will be necessary. The Bill, accordingly, makes provision for the setting up of a special maternity nurses' committee. This committee will be in a position under the Bill to deal with day to day disciplinary matters on its own initiative and it will be mandatory on the board to accept the advice of the committee on matters relating to removal from the register or the restoration to the register of names which have been removed. In other matters affecting maternity nursing it is the intention that the advice of the committee should be available to the board and provision is accordingly made in Clause 37.
Clauses 49 and 50 of the Bill will arrange for examination and training of nurses. Such arrangements must be related to rules made with the consent of the Minister. This is a considerable extension of the powers possessed by the existing body dealing with the control of the profession. I think Senators will agree that, in face of dangers of a shortage of personnel at a time when the health services are being expanded, such a power is very necessary. It is not envisaged at this stage that the body will provide a training school for hospital nurses, at least in circumstances such as they are at present or are likely to be in the foreseeable future. The new powers will make for greater flexibility in the training of nurses for the outdoor public health services. The training of the great majority of existing public health nurses has included the complete courses in general nursing and midwifery, but has not included any course specially directed to public health matters. Post-graduate courses in various aspects of nursing could also be organised under Section 50. These courses can also help to provide adequate training to fit nurses for the more responsible supervisory posts likely to arise in the future
Provision has been made in clause 53 under which the board may, on such terms and conditions as the Minister may approve, provide institutional, hostel or other accommodation for persons attending courses of training. Clause 54 of the Bill makes provision for the award of scholarships by the board under rules made with the approval of the Minister for Finance. There is no need for me to elaborate on the manner in which the powers to be conferred under this section could be utilised in the face of a shortage of personnel in any of the branches of the profession and it will be admitted that, in the face of such a shortage, it is important that suitable persons should not be debarred from training by reason of financial considerations.
A further additional power which is not immediately related to the problem of shortage of nursing personnel will be found in clause 56. This clause enables the board by rules to maintain a division of the register in respect of a profession or calling ancillary to nursing. The board will not be empowered to act under the section until the Minister makes an Order directing them to do so. The Minister's Order may require the board to appoint a committee in respect of the profession or calling. Such a committee would be appointed under clause 18 of the Bill and could include both members of the board and persons who are not members of the board, an important provision, since specialised knowledge of the particular ancillary profession would be essential for at least some members of the committee. No definite decisions have been taken as to the professions which might be allotted a division of the register in pursuance of this section but it is considered wise to include a suitable provision in the Bill for this purpose.
Finally, I shall touch briefly on the financial provisions in the Bill. It is intended that the primary source of revenue should be the examination and registration fees. In view of the additional functions proposed to be invested in the board, however, it would be impossible to rely on this source alone unless we are prepared to contemplate a position in which such fees might become so high as to defeat the very purpose of the Bill. It is proposed accordingly in clause 58 that the Minister should pay any deficit of the board out of moneys provided by the Oireachtas, and, in clause 59, that half of the amount so recouped should be apportioned by him, in proportion to the population, among the various health authorities.
The system of financial control embodied in clause 60 will ensure reasonable supervision by the Minister over the amount and purposes for which funds are required by the board. A certain amount of capital expenditure by the board will arise particularly in implementing its new powers as to training and a provision is included in the Bill under which such expenditure may be met from the Hospitals' Trust Fund.
The provisions of the Bill, if passed, will replace those of the Nurses Registration (Ireland) Act, 1919, and the provisions of the Midwives Act, 1944, so far as relates to the constitution of the Central Midwives Board and the registration of midwives. The additional powers proposed for the new board over and above those vested in the present controlling bodies are not numerous, but they are vital if we are to ensure the provision of properly trained personnel in adequate numbers for the nursing services in the coming years.
I accordingly recommend the Bill to the earnest consideration of the Seanad.